Wangelin Bethany C, Tuerk Peter W
Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center (VAMC), Charleston, South Carolina.
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
Depress Anxiety. 2015 Dec;32(12):927-34. doi: 10.1002/da.22449. Epub 2015 Nov 2.
Physiological reactivity to trauma-related cues is a primary symptom of PTSD and can be assessed objectively using script-driven imagery paradigms. However, subjective self-reported symptom measures are the most common outcome indices utilized in PTSD treatment trials and clinic settings. We examined physiological reactivity during a short trauma imagery task as an objective index of response to PTSD treatment, optimized for use in routine clinical care settings.
Participants were 35 male combat veterans receiving prolonged exposure (PE) therapy in a Veterans Affairs outpatient clinic. In addition to traditional subjective self-reported and clinician-rated symptom measures, patients also completed a script-driven imagery task in which heart rate (HR) and skin conductance (SC) were recorded at three assessment points across treatment. We examined changes in subjective symptom measures and objective trauma-specific physiological reactivity over the course of PE, and investigated the association between pretreatment physiological reactivity and treatment response.
Patients who completed PE showed significantly diminished HR and SC reactivity to trauma imagery across therapy. Additionally, individuals showing greater trauma-specific HR reactivity at pretreatment showed greater reductions in subjectively reported PTSD symptoms at posttreatment.
Findings support the utility of physiological reactivity during trauma imagery as an objective outcome measure that has the potential to be incorporated into evidence-based PTSD treatment in routine clinical settings, or prospective studies related to the individualization of care at pretreatment.
对创伤相关线索的生理反应是创伤后应激障碍（PTSD）的主要症状，可使用脚本驱动的意象范式进行客观评估。然而，主观自我报告的症状测量是PTSD治疗试验和临床环境中最常用的结果指标。我们在一项简短的创伤意象任务中检查了生理反应，将其作为对PTSD治疗反应的客观指标，并针对常规临床护理环境进行了优化。
参与者为35名在退伍军人事务门诊接受延长暴露（PE）治疗的男性退伍军人。除了传统的主观自我报告和临床医生评定的症状测量外，患者还完成了一项脚本驱动的意象任务，在治疗的三个评估点记录心率（HR）和皮肤电导率（SC）。我们研究了PE过程中主观症状测量和客观创伤特异性生理反应的变化，并调查了治疗前生理反应与治疗反应之间的关联。
完成PE治疗的患者在整个治疗过程中对创伤意象的HR和SC反应显著降低。此外，在治疗前表现出更高创伤特异性HR反应的个体在治疗后主观报告的PTSD症状减少更多。
研究结果支持将创伤意象过程中的生理反应作为一种客观结果测量方法的实用性，这种方法有可能纳入常规临床环境中的循证PTSD治疗，或与治疗前个体化护理相关的前瞻性研究。
